title: Helicobacter pylori associated vitamin B12 deficiency, pernicious anaemia and subacute combined degeneration of the spinal cord.
abstract: A 23-year-old man presented with weakness in the lower limbs, numbness in hands and feet over past 6 months. Examination revealed a combination of absent ankle jerk, extensor plantar response and reduced sensations in a glove and stocking distribution. MRI of the spinal cord was distinctive of subacute combined degeneration (SACD) of the spinal cord. Serum vitamin B12 was low and anti-intrinsic factor antibodies were positive. A biopsy of the stomach revealed intense inflammatory infiltrates in lamina propria with grade III Helicobacter pylori infection. Other work-up for the cause of vitamin B12 deficiency was unremarkable. H pylori infection triggers autoantibodies by a mechanism of molecular mimicry. This case report highlights H pylori as a causative agent in vitamin B12 deficiency and culminating in SACD of the spinal cord. H pylori treatment reverses the underlying pathogenesis and corrects vitamin B12 deficient state in selected individuals.
authors.affiliation: Department of Internal Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India.
authors.forename: H Basavana
authors.initials: HB
authors.lastname: Gowdappa
authors.forename: M
authors.initials: M
authors.lastname: Mahesh
authors.forename: K V K S N
authors.initials: KV
authors.lastname: Murthy
authors.forename: M G
authors.initials: MG
authors.lastname: Narahari
mesh_terms: D000752:Anemia, Pernicious / Q000175:diagnosis / Q000209:etiology*; D001706:Biopsy; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000382:microbiology*; D016481:Helicobacter Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D052879:Subacute Combined Degeneration / Q000175:diagnosis / Q000209:etiology*; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult